Guimarães-Ferreira José, Gewalli Fredrik, David Lisa, Darvann Tron A, Hermann Nuno V, Kreiborg Sven, Friede Hans, Lauritzen Claes G K
Institute of Human Anatomy, and Department of Plastic Surgery, University of Lisbon School of Medicine, Lisbon, Portugal.
Scand J Plast Reconstr Surg Hand Surg. 2006;40(4):200-9. doi: 10.1080/02844310600610280.
The aim of this study was to characterise the postoperative cranial growth and morphology after a modified pi-plasty for sagittal synostosis. The shape of the skull of 82 patients with isolated premature synostosis of the sagittal suture (SS group) operated on with a modified pi-plasty was studied longitudinally. Forty-five children with unilateral incomplete cleft lip (UICL), evaluated longitudinally at the ages of 2.4 and 23.2 months were used as controls. A standardised radiocephalometric technique was used for image acquisition. The radiocephalograms were analysed using a modification of a method developed by Kreiborg, which included the digitisation of 89 landmarks of the calvaria, cranial base, and orbit (43 in the lateral and 46 in the frontal projections), the production of mean shape plots for each group, and the intergroup comparison of a series of 78 variables (linear distance between selected landmarks, and angles defined by groups of three landmarks). Paired and unpaired t tests were used to assess the differences between the variables studied. These were accepted as significant for values of p<0.01 and were presented as coloured segments or areas in the respective plots. In a comparative analysis with the mean UICL lateral plots, the mean preoperative lateral plots of the study group (SS) showed that the anterior slope of the forehead was more pronounced and it was also more convex. The vertex area was located more anteriorly and was less convex. The occipital curvature was more prominent. Comparison of the mean frontal plots showed a deficiency in convexity and lateral projection of the upper parietal regions, and the line of maximum skull width was lower. The postoperative mean lateral plots of the study group showed a correction of the exaggerated anterior inclination of the forehead and a reduction of the abnormal occipital convexity. However, there was little change in the vertex region and it remained flatter than in the control group. In the mean frontal plots, the increase in convexity and in the lateral projection of the upper parietal areas led to a shape that was similar to that of the UICL group. The mean (SD) cephalic index changed from 64.9% (1.8%) to 71.4% (3.5%) (p<0.001). The longitudinal comparison between the mean postoperative plots at 3 and 5 years of age showed that there had been little change in cranial shape. In conclusion, after a modified pi-plasty for sagittal synostosis, significant objective changes in cranial shape towards normality were produced. The postoperative profile cranial shape was improved except in the vertex area, which remained flatter than normal. In the frontal projection an almost normal shape was obtained. The postoperative cranial shape obtained at 3 years of age had remained stable at the age of 5 years.
本研究的目的是描述改良π形颅骨切开术治疗矢状缝早闭后的术后颅骨生长及形态。对82例接受改良π形颅骨切开术治疗的单纯矢状缝早闭患者（矢状缝早闭组）的颅骨形状进行纵向研究。45例单侧不完全唇裂患儿（UICL），在2.4个月和23.2个月时进行纵向评估，用作对照。采用标准化的放射头颅测量技术进行图像采集。使用对Kreiborg开发的方法进行改良后的方法分析放射头颅影像，该方法包括对颅盖、颅底和眼眶的89个标志点进行数字化（侧位投影43个，正位投影46个），为每组生成平均形状图，并对一系列78个变量（选定标志点之间的线性距离以及由三个标志点组成的组定义的角度）进行组间比较。采用配对和非配对t检验评估所研究变量之间的差异。当p<0.01时，这些差异被认为具有统计学意义，并在各自的图中以彩色线段或区域表示。在与UICL组平均侧位图的对比分析中，研究组（矢状缝早闭组）术前平均侧位图显示前额前斜率更明显且更凸。头顶区域位置更靠前且凸度更小。枕骨曲率更突出。平均正位图的比较显示顶叶上部区域的凸度和侧方投影不足，最大颅骨宽度线更低。研究组术后平均侧位图显示前额过度前倾得到矫正，异常的枕骨凸度减小。然而，头顶区域变化不大，仍比对照组更扁平。在平均正位图中，顶叶上部区域凸度和侧方投影的增加导致其形状与UICL组相似。平均（标准差）头指数从64.9%（1.8%）变为71.4%（3.5%）（p<0.001）。3岁和5岁时术后平均图的纵向比较显示颅骨形状变化不大。总之，改良π形颅骨切开术治疗矢状缝早闭后，颅骨形状朝着正常方向产生了显著的客观变化。术后侧面颅骨形状得到改善，但头顶区域除外，该区域仍比正常更扁平。在正位投影中获得了几乎正常的形状。3岁时获得的术后颅骨形状在5岁时保持稳定。
